{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:48:31Z","timestamp":1782452911707,"version":"3.54.5"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Intravenous push (IVP) beta-lactam antibiotics have been adopted during parenteral solution shortages to conserve resources. Data evaluating the safety and efficacy of cefepime administered IVP versus intravenous piggyback (IVPB) infusion in Gram-negative bacteremia remain limited. We compared clinical outcomes of cefepime administered IVP versus IVPB in hospitalized patients with Gram-negative bacteremia. Methods: This was a retrospective cohort study across a five-hospital health system from 1 January 2014 through 31 December 2021. Adults receiving cefepime for Gram-negative bacteremia were included. The primary outcome was a tailored desirability of outcome ranking (DOOR) composite assessed through 30 days or hospital discharge, integrating clinical cure and cefepime-associated neurologic adverse effects. Clinical cure was defined as absence of recurrent bacteremia with the index pathogen after 48 h, no antibiotic escalation, and no in-hospital mortality. Results: A total of 254 met the inclusion criteria (127 IVPB; 127 IVP). Baseline severity was similar between groups. The primary outcome assessed by DOOR revealed no difference between IVPB and IVP groups (p = 0.656). Vasopressor support during therapy was more frequent in the IVP group (22.0% vs. 10.2%, p = 0.011), and median hospital length of stay was longer (10 vs. 7 days, p = 0.020). No differences were noted in other endpoints. General ward admission (OIR [aOR] 2.563, 95% CI 1.271\u20135.168; p = 0.009) and genitourinary source of bacteremia (aOR 3.398, 95% CI 1.509\u20137.652; p = 0.003) independently predicted clinical cure. Conclusions: In patients with Gram-negative bacteremia, cefepime administered IVP demonstrated similar safety and efficacy to IVPB infusion.<\/jats:p>","DOI":"10.3390\/jcm15124768","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:04:04Z","timestamp":1781874244000},"page":"4768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Safety and Efficacy of Cefepime Administered via Intravenous Push Versus Intravenous Piggyback Infusion in Patients with Gram-Negative Bacteremia"],"prefix":"10.3390","volume":"15","author":[{"given":"Mary","family":"Fronrath","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Henry Ford Hospital, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Martz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Henry Ford Hospital, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7637-7096","authenticated-orcid":false,"given":"Kristin","family":"Griebe","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Henry Ford Hospital, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Veve","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Henry Ford Hospital, Detroit, MI 48202, USA"},{"name":"Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8221-1108","authenticated-orcid":false,"given":"Zachary R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Henry Ford Hospital, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1592\/phco.26.9.1320","article-title":"Application of antimicrobial pharmacodynamic concepts into clinical practice: Focus on \u03b2-lactam antibiotics","volume":"26","author":"Lodis","year":"2006","journal-title":"Pharmacotherapy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/phar.2505","article-title":"A guide to therapeutic drug monitoring of \u03b2-lactam antibiotics","volume":"41","author":"Fratoni","year":"2021","journal-title":"Pharmacotherapy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1093\/cid\/cix648","article-title":"Follow-up blood cultures in gram-negative bacteremia: Are they needed?","volume":"65","author":"Canzoneri","year":"2017","journal-title":"Clin. Inf. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1128\/CMR.00036-08","article-title":"AmpC beta-lactamases","volume":"22","author":"Jacoby","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","unstructured":"U.S. Food and Drug Administration (2021, August 04). Baxter: Temporary Importation of Intravenous Drug Products to Address Drug Shortages, Available online: https:\/\/www.fda.gov\/media\/108110\/download."},{"key":"ref_6","unstructured":"American Society of Health-System Pharmacists (2017). Small-Volume Parenteral Solutions Shortages, American Society of Health-System Pharmacists."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ijid.2021.07.018","article-title":"Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting","volume":"110","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Smith, S.E., Halbig, Z., Fox, N.R., Bland, C.M., and Branan, T.N. (2023). Outcomes of Intravenous Push versus Intermittent Infusion Administration of Cefepime in Critically Ill Patients. Antibiotics, 12.","DOI":"10.3390\/antibiotics12060996"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e242","DOI":"10.1093\/ajhp\/zxaf296","article-title":"IV push cefepime for Pseudomonas aeruginosa infections in critically ill patients: Convenience over quality care?","volume":"83","author":"Bland","year":"2026","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/jcpt.13291","article-title":"Intravenous push versus intravenous piggyback beta-lactams for the empiric management of gram-negative bacteremia","volume":"46","author":"Marsh","year":"2021","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1186\/s13054-017-1856-1","article-title":"Cefepime-induced neurotoxicity: A systematic review","volume":"21","author":"Payne","year":"2017","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1093\/cid\/civ495","article-title":"Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR)","volume":"61","author":"Evans","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1592\/phco.31.6.527","article-title":"High-dose daptomycin for treatment of complicated gram-positive infections: A large, multicenter, retrospective study","volume":"31","author":"Kullar","year":"2011","journal-title":"Pharmacotherapy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1001\/jamainternmed.2017.1938","article-title":"Association of adverse events with antibiotic use in hospitalized patients","volume":"177","author":"Tamma","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.chest.2020.01.051","article-title":"Effect of cefepime on neurotoxicity development in critically ill adults with renal dysfunction","volume":"158","author":"Khan","year":"2020","journal-title":"CHEST"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/1469-0691.12085","article-title":"Predictive scoring model of mortality in Gram-negative bloodstream infection","volume":"19","author":"Lahr","year":"2013","journal-title":"Clin. Microb. Inf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/cid\/ciy1054","article-title":"Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: A noninferiority randomized controlled trial","volume":"69","author":"Yahav","year":"2019","journal-title":"Clin. Inf. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1017\/ash.2022.301","article-title":"Changing times: The impact of gram-negative breakpoint changes over the previous decade","volume":"2","author":"Johnson","year":"2022","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.cll.2020.07.001","article-title":"Modern Blood Culture: Management Decisions and Method Options","volume":"40","author":"Gonzalez","year":"2020","journal-title":"Clin. Lab. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tamma, P.D., Heil, E.L., Justo, J.A., Mathers, A.J., Satlin, M.J., and Bonomo, R.A. (2024). Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin. Infect. Dis., ciae403.","DOI":"10.1093\/cid\/ciae403"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:21:15Z","timestamp":1782451275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124768"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124768","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]}}}